Provider Demographics
NPI:1861686693
Name:MEDIX HEALTHCARE, INC
Entity Type:Organization
Organization Name:MEDIX HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CLEVELAND
Authorized Official - Middle Name:SAN JUAN
Authorized Official - Last Name:ESTRELLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:909-985-9868
Mailing Address - Street 1:869 E FOOTHILL BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4063
Mailing Address - Country:US
Mailing Address - Phone:909-985-9868
Mailing Address - Fax:909-985-9868
Practice Address - Street 1:869 E FOOTHILL BLVD STE H
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4063
Practice Address - Country:US
Practice Address - Phone:909-985-9868
Practice Address - Fax:909-985-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAINTITAL APPLICATIONOtherINITIAL APPLICATION